Professor Deborah Johnston on the economics of HIV

Since the start of the AIDS epidemic 76.1 million people have become infected, while globally 36.7 million people were living with HIV in 2016. In order to help raise awareness of #WorldAidsDay we spoke with Professor Deborah Johnston from SOAS University of London to learn more about the impacts that economic policy has on the spread of HIV.

Q1. In your book you talk about microeconomics and macroeconomic causes of HIV, what do you mean by this?

Ill health is often a reflection of economic and social factors. If we look at the acquisition of HIV, there are two ways that economics plays a role. First, economic change can lead to a change in people’s sexual and partnering behaviour. So certain kinds of migration, occupation, inequality and poverty can all change the way in which we choose intimate partners. Second, economics determines the effectiveness of health systems and economic policy affects the obligations employers have towards their workers. And this is particularly important given the role of timely medication in reducing HIV transmission. When you get down to it, we can see that the structure of economies leads to certain patterns of HIV risk.

Q2. Can people really argue that AIDS is a good thing for economic development?

People can’t argue it well, but it’s an argument that keeps coming back. This kind of argument comes from two kinds of simplification. First a simplified view of history- that thinks that mass epidemics promote faster economic growth, because having less people means that we’ve an incentive to a more effective use of labour, raising productivity, skills and wages. My view is that for every example that seems to show this, there are plenty others that show the exact opposite.

The second kind of simplification is the simplification of theory – and this really shows the weakness of mainstream economics. This is the idea that people will act in predictable and positive ways in response to widespread mortality. One author suggests that AIDS will lead to higher education because there’ll be fewer children and we can devote more resources to them. That is a mis-reading of lots of things. It certainly doesn’t seem to capture the way that HIV/AIDS can negatively affect public expenditure, teachers and household finances.

Q3. How can our understanding of political economics help prevent the spread of HIV?

Political economy starts by understanding how markets are constructed and who benefits from them. A political economy approach to the spread of HIV starts by understanding how risk can be magnified by certain kinds of economic structure. For example, failing to give residence rights to the families of migrants tends to split families and increase the number of partners that migrants have. One author suggests that we should work with the idea of the political economy of intimacy. I like this as a concept. We may not recognise it on a day to day basis, but our choices about partners are affected by our economic, social and legal rights.

Professor Deborah Johnston is a Professor in Development Economics here at SOAS University of London. Her research focuses on the analysis and measurement of poverty, the working of rural labour markets, agrarian change and rural development, and the socio-economic impact of HIV/AIDS. She is also the author of Economics and HIV: The Sickness of Economics.